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					                                                                                                                                                       Records Code: LS701-XDFR

                     PUBLIC SERVICE DEFERMENT REQUEST                                                                                                             OMB No. 1845-0005
                                                                                                                                                                  Form Approved
                     Federal Family Education Loan Program                                                                                                        Exp. Date 05/31/2012

                     Use this form only if you have an outstanding balance on a Federal Family Education Loan Program loan that was made before July 1, 1993, or had
                     a balance on a loan that was made before July 1, 1993, at the time you obtained a loan disbursed on or after July 1, 1993.
                     WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents is subject to
    PUB              penalties that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

SECTION 1: BORROWER IDENTIFICATION
                                                                                                     Please enter or correct the following information.
                                                                                                     SSN |__|__|__|-|__|__|-|__|__|__|__|
                                                                                                     Name
                                                                                                     Address
                                                                                                     City, State, Zip Code
                                                                                                     Telephone - Home (        )
                                                                                                     Telephone - Other (       )
                                                                                                     E-mail Address (Optional)
SECTION 2: DEFERMENT REQUEST
Before answering any questions, carefully read the entire form, including the instructions and other information in Sections 5, 6, and 7.
 I meet the qualifications stated in Section 7 for the deferment checked below and request that my loan holder defer repayment of my loan(s) while I am:
       On active duty in the ARMED FORCES of the United States.
       Serving full time as an officer in the Commissioned Corps of the PUBLIC HEALTH SERVICE.
       Serving in the PEACE CORPS.
       A full-time paid volunteer in the ACTION PROGRAMS.
       A full-time paid volunteer for a TAX-EXEMPT ORGANIZATION.
       On active duty in the NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION (NOAA).
        The NOAA Deferment is available only to Federal Stafford and SLS loan borrowers whose first loans were made on or after July 1, 1987, and before July 1, 1993, or
        borrowers who had a balance on a loan that was made on or after July 1, 1987, and before July 1, 1993, at the time a loan was disbursed on or after July 1, 1993.
   NOTE: Federal PLUS Loans made on or after August 15, 1983, and Federal Consolidation Loans do not qualify for these deferments.
SECTION 3: BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
 I understand that:
   (1) I am not required to make payments of loan principal during my deferment. Interest will not be charged on my subsidized loan(s) during my deferment. However, interest will
       be charged on my unsubsidized loan(s).
   (2) I have the option of paying the interest that accrues on my unsubsidized loan(s) during my deferment.
   (3) I may choose to make interest payments by checking the box below. My loan holder may capitalize interest that I do not pay during the deferment period.
            I wish to make interest payments on my unsubsidized loan(s) during my deferment.
   (4) My deferment will begin on the date I began performing the public service that qualifies me for the deferment, as certified by the authorized official who completes Section 4 of
       this form.
   (5) My deferment will end on the earlier of the date that I stop performing the public service that qualifies me for the deferment, or the ending date of my qualifying public service, as
       certified by the authorized official.
   (6) If my deferment does not cover all my past due payments, my loan holder may grant me a forbearance for all payments due before the begin date of my deferment or—if the
       period for which I am eligible for a deferment has ended—a forbearance for all payments due at the time my deferment request is processed.
   (7) My loan holder may grant me a forbearance on my loans for up to 60 days, if necessary, for the collection and processing of documentation related to my deferment request.
       Interest that accrues during the forbearance will not be capitalized.
 I certify that: (1) The information I provided in Sections 1 and 2 above is true and correct. (2) I will provide additional documentation to my loan holder, as required, to support my
   deferment status. (3) I will notify my loan holder immediately when the condition(s) that qualified me for the deferment ends. (4) I have read, understand, and meet the eligibility
   criteria of the deferment for which I have applied, as explained in Section 7.
 I authorize the school, the lender, the guarantor, the Department, and their respective agents and contractors to contact me regarding my loan(s), including repayment of my
   loan(s), at the current or any future number that I provide for my cellular telephone or other wireless device using automated telephone dialing equipment or artificial or prerecorded
   voice or text messages.
Borrower’s Signature                                                                                                                     Date

SECTION 4: AUTHORIZED OFFICIAL’S CERTIFICATION
I certify, to the best of my knowledge and belief, that the borrower named above is/was engaged in the service indicated in Section 2, and that the borrower and the borrower’s service
meet all the eligibility requirements specified in Section 7.
The borrower’s service began on |__|__|-|__|__|-|__|__|__|__| and is expected to end/ended on |__|__|-|__|__|-|__|__|__|__|.
Name of Organization
Address                                                                                                                   City, State, Zip Code
Name/Title of Authorized Official                                                                                         Telephone (          )
Authorized Official’s Signature                                                                                           Date

                                                                                           Page 1 of 3
SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM
Type or print using dark ink. Report dates as month-day-year (MM-DD-YYYY). For example, ‘January 31, 2009’ = ‘01-31-2009’. An authorized official must either complete Section 4
or attach the organization’s own certification listing the required information. If you need help completing this form, contact your loan holder.
Return the completed form and any required documentation to the address shown in Section 8.
SECTION 6: DEFINITIONS
 Authorized certifying officials:
   •   Commanding or Personnel Officer (Armed Forces Deferment)
   •   Authorized Official of the U. S. Public Health Service (Public Health Service Deferment)
   •   Authorized Official of the Peace Corps (Peace Corps Deferment)
   •   Authorized Official of the ACTION Program (ACTION Program Deferment)
   •   Authorized Official of the Volunteer Program (Tax-Exempt Organization Deferment)
   •   Authorized Official of the NOAA Corps (NOAA Deferment)
 Capitalization is the addition of unpaid interest to the principal balance of my loan. The principal balance of a loan increases when payments are postponed during periods of
  deferment or forbearance and unpaid interest is capitalized. As a result, more interest may accrue over the life of the loan, the monthly payment amount may be higher, or more
  payments may be required. The chart below provides estimates, for a $15,000 unsubsidized loan balance at a 9% interest rate, of the monthly payments due following a 12-month
  deferment. It compares the effects of paying the interest as it accrues, capitalizing the interest at the end of the deferment, and capitalizing interest quarterly and at the end of the
  deferment. My actual loan interest cost will depend on my interest rate, length of the deferment, and frequency of capitalization. Paying interest during the period of deferment
  lowers the monthly payment by about $18 and saves about $772 over the lifetime of the loan, as depicted in the chart below.
             Treatment of Interest Accrued                 Loan         Capitalized Interest    Principal to           Monthly       Number of       Total Amount        Total Interest
                     During Deferment                     Amount          for 12 Months           Be Repaid            Payment       Payments           Repaid               Paid
      Interest is paid                                   $15,000.00            $0.00             $15,000.00            $190.01          120           $24,151.64*         $9,151.64
      Interest is capitalized at the end of deferment    $15,000.00          $1,350.00           $16,350.00            $207.11          120           $24,853.79          $9,853.79
      Interest is capitalized quarterly during
                                                         $15,000.00          $1,396.25           $16,396.25            $207.70           120           $24,924.09          $9,924.09
      deferment and at the end of deferment
   *Total amount repaid includes $1,350 of interest paid during the 12-month period of deferment.
 A deferment is a period during which I am entitled to postpone repayment of the principal balance of my loan(s). The federal government pays the interest that accrues during an
  eligible deferment for all subsidized Federal Stafford Loans and for Federal Consolidation Loans for which the Consolidation Loan application was received by my loan holder (1)
  on or after January 1, 1993, but before August 10, 1993, (2) on or after August 10, 1993, if it includes only Federal Stafford Loans that were eligible for federal interest subsidy, or
  (3) on or after November 13, 1997, for that portion of the Consolidation Loan that paid a subsidized FFEL Program loan or a subsidized Federal Direct Loan. I am responsible for
  the interest that accrues during this period on all other FFEL Program loans.
 The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans (both subsidized and unsubsidized), Federal Supplemental Loans for Students (SLS),
  Federal PLUS Loans, and Federal Consolidation Loans.
 Forbearance means permitting the temporary cessation of payments, allowing an extension of time for making payments, or temporarily accepting smaller payments than
  previously scheduled. I am responsible for paying the interest that accrues on my loan(s) during a forbearance. If I do not pay the interest that accrues, the interest may be
  capitalized.
 The holder of my FFEL Program loan(s) may be a lender, guaranty agency, secondary market, or the U.S. Department of Education.
SECTION 7: ELIGIBILITY CRITERIA FOR PUBLIC SERVICE DEFERMENT REQUEST
 To qualify for any of the deferments listed in Section 2 of this form:
   • I must have an outstanding balance on a FFEL Program loan which was made before July 1, 1993, or I must have had an outstanding balance on a FFEL Program loan made
      before July 1, 1993, when I obtained a loan disbursed on or after July 1, 1993. If I am a Federal PLUS Loan borrower, (1) I am not eligible for the NOAA Deferment, and (2) I
      am eligible for the Armed Forces, Public Health Service, Peace Corps, ACTION Programs, and Tax-Exempt Organization Deferments only on the loan(s) made before August
      15, 1983. I am eligible for the NOAA Deferment only if I am a Federal Stafford or SLS loan borrower whose first loan was made on or after July 1, 1987, and before July 1,
      1993, or I had an outstanding balance on a loan made on or after July 1, 1987, and before July 1, 1993, when I obtained a loan on or after July 1, 1993.
 I may defer repayment of my loan(s) while I am:
   • On active duty in the ARMED FORCES of the United States. (Maximum eligibility is 3 years; this is a combined limit with Public Health Service and NOAA deferments.) To
     qualify, I must: (1) be on active duty in the Army, Navy, Air Force, Marine Corps or Coast Guard, and (2) provide my loan holder with copies of my military identification and
     orders or have my commanding or personnel officer certify Section 4 on the front of this form. Note: Borrowers enlisted in a reserve component of the Armed Forces or the
     National Guard (while on active duty status in the Army or Air Force Reserves) may qualify for this deferment only if: (1) serving full time for a period expected to last at least 1
     year, or (2) serving under an order for national mobilization.
   • Serving full time as an officer in the Commissioned Corps of the PUBLIC HEALTH SERVICE. (Maximum eligibility is 3 years; this is a combined limit with Armed Forces and
     NOAA deferments.)
   • Serving in the PEACE CORPS. (Maximum eligibility is 3 years.) To qualify, I must have agreed to serve for a period of at least 1 year. Note: As an alternative to having an
     authorized Peace Corps official complete Section 4 of this form, you may provide your loan holder with documentation of the beginning and expected ending dates of your
     service in the Peace Corps. This documentation must be signed and dated by an authorized Peace Corps official.
   • A full-time paid volunteer in the ACTION PROGRAMS. (Maximum eligibility is 3 years.) To qualify, I must have agreed to serve for a period of at least 1 year.
   • A full-time paid volunteer for a TAX-EXEMPT ORGANIZATION. (Maximum eligibility is 3 years.) To qualify, I must: (1) be serving full time in an organization that has a tax
     exemption under Section 501(c)(3) of the Internal Revenue Code of 1986; (2) assist low income people and their communities in eliminating poverty and poverty-related human,
     social, and environmental conditions; (3) not earn more than the federal minimum wage; however, I may receive fringe benefits like those received by other employees of the
     organization; (4) not engage in religious instruction, proselytizing, fund-raising to support religious activities, or conduct worship services as part of my duties; and (5) have
     agreed to serve for a period of at least 1 year.
   • On active duty in the NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION (NOAA). (Maximum eligibility is 3 years; this is a combined limit with Armed Forces and
     Public Health Service Deferments.)




                                                                                      Page 2 of 3
SECTION 8: WHERE TO SEND THE COMPLETED DEFERMENT REQUEST
Return the completed deferment request and any required documentation to:                         If you need help completing this form, call: 800-699-2908
(If no address is shown, return to your loan holder.)                                             (If no telephone number is shown, call your loan holder.)
                                                      U.S. Department of Education                 If you are calling internationally, call: 717-720-1985
                                                      FedLoan Servicing                            If you use a telecommunications device for the deaf (TDD), call: 800-722-8189
                                                      P.O. Box 69184
                                                      Harrisburg, PA 17106-9184
                                                      Or Fax to: 717-720-1628                      Web site: www.MyFedLoan.org

SECTION 9: IMPORTANT NOTICES
Privacy Act Notice
The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you:
The authority for collecting the requested information from and about you is §421 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1071 et seq.) and the
authorities for collecting and using your Social Security Number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and 31 U.S.C. 7701(b). Participating in the Federal Family
Education Loan Program (FFELP) and giving us your SSN are voluntary, but you must provide the requested information, including your SSN, to participate.
The principal purposes for collecting the information on this form, including your SSN, are to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan
(such as a deferment, forbearance, discharge, or forgiveness) under the FFELP, to permit the servicing of your loan(s), and, if it becomes necessary, to locate you and to collect and
report on your loan(s) if your loan(s) becomes delinquent or in default. We also use your SSN as an account identifier and to permit you to access your account information
electronically.
The information in your file may be disclosed, on a case-by-case basis or under a computer matching program, to third parties as authorized under routine uses in the appropriate
systems of records notices. The routine uses of this information include, but are not limited to, its disclosure to federal, state, or local agencies, to private parties such as relatives,
present and former employers, business and personal associates, to consumer reporting agencies, to financial and educational institutions, and to guaranty agencies in order to verify
your identity, to determine your eligibility to receive a loan or a benefit on a loan, to permit the servicing or collection of your loan(s), to enforce the terms of the loan(s), to investigate
possible fraud and to verify compliance with federal student financial aid program regulations, or to locate you if you become delinquent in your loan payments or if you default. To
provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies. To provide financial aid history
information, disclosures may be made to educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to federal or state agencies. To provide a standardized method for educational institutions to efficiently submit student enrollment
status, disclosures may be made to guaranty agencies or to financial and educational institutions. To counsel you in repayment efforts, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to federal, state, or local agencies.
In the event of litigation, we may send records to the Department of Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant and necessary to the
litigation. If this information, either alone or with other information, indicates a potential violation of law, we may send it to the appropriate authority for action. We may send
information to members of Congress if you ask them to help you with federal student aid questions. In circumstances involving employment complaints, grievances, or disciplinary
actions, we may disclose relevant records to adjudicate or investigate the issues. If provided for by a collective bargaining agreement, we may disclose records to a labor organization
recognized under 5 U.S.C. Chapter 71. Disclosures may be made to our contractors for the purpose of performing any programmatic function that requires disclosure of records.
Before making any such disclosure, we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made to qualified researchers under Privacy Act
safeguards.
Paperwork Reduction Notice
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a currently valid OMB control number. The
valid OMB control number for this information collection is 1845-0005. The time required to complete this information collection is estimated to average 0.16 hours (10 minutes) per
response, including the time to review instructions, search existing data resources, gather and maintain the data needed, and complete and review the information collection. If you
have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:
U.S. Department of Education, Washington, DC 20202-4537
If you have questions regarding the status of your individual submission of this form, write directly to the address shown in Section 8.




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